Strengthening Aboriginal family involvement in the paediatric ESCALATION system: A multi-methods study of Aboriginal families' experiences in raising concerns

PURPOSE: To explore Aboriginal families' experiences of recognising clinical deterioration and raising their concerns within the Paediatric ESCALATION system to identify enablers and barriers to family involvement. DESIGN AND METHODS: A multi-methods descriptive design applying the Practical Robust Implementation and Sustainability Model (PRISM) framework with an Aboriginal Participatory Action Research approach. This is stage one of a multisite three-staged pre-post intervention trial. Parents/caregivers of Aboriginal children were recruited from three sites to complete a survey on caregivers' awareness, attitudes to raising concerns, and health professionals' responsiveness, and/or an interview/focus group exploring caregivers' experiences. Surveys were analysed descriptively, and interviews/focus groups were analysed thematically. RESULTS: Eighty-six caregivers completed surveys. Caregivers reported feeling included and comfortable speaking up, but health professional support and timely response were less consistent. Thirty-seven caregivers participated in interviews/focus groups. Four themes viewed through the PRISM framework described family experiences: i) Family knows best (Recipients (Caregivers) Perspectives), ii) Feeling comfortable speaking up (Implementation & Sustainability Infrastructure), iii) Speaking up is not easy (Implementation & Sustainability Infrastructure), iv) Culturally secure care (External Environment). CONCLUSION: Caregivers of Aboriginal children confidently voice concerns when health professionals listen and provide timely responses in culturally responsive ways. Supporting hospital-wide care delivery of these enabling factors is essential for improving Aboriginal family involvement in the ESCALATION system. Findings will inform tailored solutions to enhance Aboriginal family involvement in escalating care. PRACTICE IMPLICATIONS: A system-wide approach integrating Aboriginal staff, culturally appropriate resources, effective communication, respectful rapport, and health information empowers Aboriginal families to escalate concerns.